Emerging Issues in Sexually Transmitted Diseases. Webinar. Managing STDs in Correctional Settings: Behind the Walls

Transcription

1 Emerging Issues in Sexually Transmitted Diseases Webinar Managing STDs in Correctional Settings: Behind the Walls Please listen to the webinar on your computer using speakers or a headset. We will compile and answer salient questions from the webinar and will post them online at and as soon as we can. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention

2 Disclosures CDC, our planners, and our presenters wish to disclose they have no financial interests or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters. Presentations will not include any discussion of the unlabeled use of a product or a product under investigational use with the exception of Drs. Bolan and Lincoln s discussion on STD screening in correctional facilities. They will be discussing NAA tests from alternate body sites. CDC does not accept any commercial support. 2

3 CME: Continuing Education Accreditation The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Continuing Medical Education (ACCME ) to provide continuing medical education for physicians. The Centers for Disease Control and Prevention designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. Continuing Education designated for Non-Physicians: Non-physicians will receive a certificate of participation. Continuing Nursing Education for Nurses (CNE): The Centers for Disease Control and Prevention is accredited as a provider of Continuing Nursing Education by the American Nurses Credentialing Center's Commission on Accreditation. This activity provides 1.5 contact hours. 3

4 Continuing Education Accreditation IACET Continuing Education Units (CEU): The CDC has been approved as an Authorized Provider by the International Association for Continuing Education and Training (IACET), 1760 Old Meadow Road, Suite 500, McLean, VA The CDC is authorized by IACET to offer 0.2 ANSI/IACET CEUs for this program. Continuing Education Contact Hours in Health Education (CECH): Sponsored by the Centers for Disease Control and Prevention, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designed for Certified Health Education Specialists (CHES) to receive up to 1.5 Category I CECH in health education. CDC provider number GA

5 Continuing Education Accreditation Continuing Pharmacy Education (CPE): The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is a designated event for pharmacists to receive 0.15 Contact Hours in pharmacy education. The Universal Activity Number is EC1956 is L01-P. For WD1956 the UAN is H01-P. Course Category: This activity has been designated as Knowledge- Based. There is no fee for this course. 5

6 Instructions on how to receive Continuing Education credits will be available at the end of the webinar and will also be ed to you following the live webinar. A link to the archived version of the Webinar will be available at within a few days. If you have questions about screening and treating persons in correctional facilities for STDs following the Webinar you may submit them to [email protected]. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention

7 Emerging Issues in Sexually Transmitted Diseases Managing STDs in Correctional Settings: Behind the Walls November 9, 2011 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention

8 Gail Bolan, MD Director Division of STD Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention 8

9 Learning Objectives Discuss clinical significance of the sexual health/clinical issue. Describe epidemiological trends related to the sexual health/clinical issue. Identify key screening and treatment recommendations for management of the sexual health/clinical issue, in accordance with CDC 2010 STD Treatment Guidelines. Promote health improvement, wellness, and disease prevention in cooperation with patients, communities, atrisk populations, and other members of an interprofessional team of health care providers. 9

10 Presenters Anne Spaulding, MD, MPH Assistant Prof. of Epidemiology and of Medicine Emory University Thomas Lincoln, MD Medical Director Hampden County Correctional Center Assistant Prof. of Medicine Baystate Medical Center/ Tufts University School of Medicine Sharon Adler, MD, MPH Clinical Faculty California STD/HIV Prevention Training Center Clinical Specialist California Department of Public Health STD Control Branch 10

11 Webinar Overview Epidemiology of STDs in correctional facilities Health consequences of untreated STDs STD screening in correctional facilities 2010 STD Treatment Guidelines relevant to persons in correctional facilities Additional resources Question and answer session 11

12 How many people are watching the webinar with you? Watching solo 2 in room 3 in room 4-10 in room >10 in room

13 What is your primary profession or discipline? RN APRN (NP, CNM) or PA MD/DO Public health professional Other

14 What is your area of expertise? General Medicine/Family Practice Adult Medicine Women s Health/Ob-Gyn Pediatric/Adolescent Medicine Other

15 What type of correctional facility do you work in most of the time? Adult Jail Adult Federal or State Prison Juvenile Detention Center or other facility primarily serving youth Other correctional facility Not currently working in a correctional setting

16 Anne Spaulding, MD, MPH Assistant Professor of Medicine Assistant Professor of Epidemiology Emory University 16

17 Overview: Epidemiology of STDs in Corrections Where inmates are located in the U.S. criminal justice system Why jails concentrate STDs particularly well The potential impact of jail screening for STDs 17

18 June 2008: 2.4 million persons behind walls N =7.4 Million 5 M Jail Federal Prison State Prison Probation/Parole And Juveniles Bureau of Justice Statistics ( data) 18

19 Prison and Jail Populations at a Single Point in Time: Data from June 2008 Approximately twice as many offenders are in prison than jail on any given day Prison N = 1.6 Million Jail N = 0.8 Million Bureau of Justice Statistics ( data) 19

20 Rapid Turnover in Jails Prison Number of Individuals Discharged from Prisons and Jails across One Year Jail Approximately 95% of the 10 million offenders discharged from the criminal justice system each year are released from jails* Spaulding, PLoS One

21 Jails Concentrate STDs Chlamydia Prevalence among non-institutionalized men and women ~2%. 1 Incarcerated prevalence much higher - Highest prevalence in girls in juvenile detention facilities and women up to age 35 in adult facilities % among Females <20 yrs of age 10.8 % among Men < 20yrs of age 1 National Health and Nutrition Examination Survey (NHANES) 2 Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance,

22 Chlamydia & Gonorrhea by Age and Sex in Juvenile Corrections Facilities, 2009 Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2009 available at 22

23 Chlamydia & Gonorrhea by Age and Sex in Adult Corrections Facilities, 2009 Chlamydia Gonorrhea Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2009 available at 23

24 GC and CT in Women: Testing women 35 years at Fulton County Jail found most infections No. of Tests GC+ (%) CT+ (%) 35 years (2.8%) 90 (10.1%) >35 years (1.4%) 11 (2.1%) Total (2.3%) 101 (7.2%) 24

25 Impact of Jail Screening on Community Chlamydia Rates: San Francisco 25

26 Objective and Method Determine whether screening adults in jail can impact community CT rates Describe CT trends among females aged years at 2 neighborhood clinics with different incarceration rates 26

27 Jail Screening Evaluation San Francisco, Intervention Sample Population Jail Screening Males Females Clinic S Positivity Females Clinic O Positivity Females 15 25

28 Jail Testing Density Number of Males and Females tested at least once in jail during Year 2000 Census population For Males and Females

29 Jail Chlamydia Testing Density by Neighborhood, Per 1,000 Population 200 to to to 99 3 to

30 Female Chlamydia Rates and Jail Testing Density by Neighborhood, 2004 Female Chlamydia Rate Per 100,000 Population 750 to 1, to to to 249 Jail Chlamydia Testing Density Per 1,000 Population 200 to to to 99 3 to 49 30

31 Jail Chlamydia Testing Density and Females Tested in Clinics by neighborhood and clinic, Clinic S (N=1,052) Clinic O (N=230) Jail Testing Per 1,000 Population 200 to to to to 50 31

32 Chlamydia Positivity Among Females Aged Years by Clinic and Year 32

33 Jails Concentrate STDs Syphilis Primary and Secondary (P&S) syphilis case rates are significantly lower than CT and GC. 2 Studies have shown that patients diagnosed with syphilis in the community had a history of incarceration prior to their diagnosis. 3 - Concerns older correctional population - Most cases represent old infections Still important to screen in high prevalence areas. 2 Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, Burke, R. and J. Rhodes (2009). "Lessons learned on the implementation of jail syphilis screening in Nashville, Davidson County Jail, " Sexually Transmitted Diseases 36(2 Suppl). 33

34 Screening Time Element 10 million persons pass through jails each year - Median length of stay is 48 hours - Need for quick Testing Return of results 34

35 Implications for Programs & Policy Implementation of selective screening & treatment programs for young men and women in jails might reduce community prevalence in females. Through targeted screening & innovative treatment strategies, correctional screening programs can use their limited resources more effectively. 35

36 Thomas Lincoln, MD Medical Director Hampden County Correctional Center Baystate Brightwood Health Center Assistant Professor of Medicine Tufts University School of Medicine 36

37 Health Consequences of Untreated STDs Women s reproductive health Untreated Chlamydia (CT) or gonorrhea (GC) may lead to pelvic inflammatory disease (PID) Leading infectious cause of infertility in the U.S. Infant mortality/morbidity Neonatal HIV, herpes simplex virus (HSV) and congenital syphilis Multiple other organ system infections and consequences of infection HIV transmission and acquisition 37

38 Overview: STD Screening In Corrections Who to screen in correctional facilities Details regarding MSM and HIV-infected Which STDs to screen for STD re-screening in previously infected individuals Newer laboratory assays used to screen for STDs 38

39 In your correctional setting, which STDs are routinely screened for during intake? Chlamydia Gonorrhea Syphilis HIV Trichomonas

40 Screening in Corrections: 2010 STD Treatment Guidelines Persons in Correctional Facilities added to Special Populations Universal screening for chlamydia and gonorrhea Adolescent females at intake in juvenile detention or jail facilities Adult females up to 35 years of age (or based on local institutional prevalence data) at intake Universal screening for syphilis Based on local prevalence of infectious syphilis (primary, secondary, and early latent syphilis) Consider screening sexually active young men for chlamydia in clinical settings of high prevalence However, women are the priority 40

41 Screening in Corrections: Chlamydia Screening Cost effectiveness varies with prevalence and gender Cost-effective if prevalence >5% in females Higher prevalence in males required for costeffectiveness Jail screening can be major component of population testing - NYC Ecological studies: - San Francisco - community rates in young women fell in clinic serving neighborhood with high jail testing and treatment and not in clinic in neighborhood with low - Philadelphia- in similar study did not find difference in declining rates by neighborhood Kraut-Becher JR McDonnell DD Gift TL Kahn Hammett Peterman

42 Chlamydia Infections By Clinical Setting: NYC males 35 years old *numbers in parentheses represent % of citywide cases; **includes cases reported from non-nyc jails and NYC jails without universal screening programs. Pathela et al., Sex Trans Dis

43 Screening in Corrections Gonorrhea screening Similar cost-effectiveness analyses to chlamydia, but prevalence is generally below cost-effectiveness threshold Syphilis screening Had been routine or mandatory in most prison systems and a fraction of jails Large variation in impact based on local prevalence Computerized registry to interpret positive serology Kraut Kahn Hammett Blank Burke

44 STD Screening for MSM HIV Syphilis Gonorrhea and chlamydia Urethral Rectal (if receptive anal intercourse) Pharyngeal (if receptive oral intercourse), gonorrhea only Hepatitis B (HBsAg) Hepatitis C If history of IV drug abuse If HIV+ HSV-2 serology (consider) Anal Pap (consider for HIV+) Frequency At least annually, more frequently (every 3-6 months) if at high risk (multiple, anonymous, and/or high risk partners; drug use) 44

45 Chlamydia and Gonorrhea Infections: Proportion not identified if screening MSM only at urine/urethral sites 53% 47% 64% 36% Chlamydia Gonorrhea Identified Not Identified Kent, CK et al, Clin Infect Dis July

46 GC/CT Screening Tests Nucleic acid amplification tests Urine in men and vaginal swab in women are the best NAAT specimens to collect NAATs Extragenital Sites Not FDA-cleared for rectal or pharyngeal specimens but now the preferred testing method over culture Validation procedures can be done by labs to allow use of a non-fda-cleared test or application Multiple commercial labs currently provide gonorrhea/chlamydia NAAT for rectal/pharyngeal specimens Non-culture, non-amplified l tests such as EIA and DNA probe are inferior to NAATs and not recommended. Urine leukocytes not sensitive or specific enough for screening algorithm. 46

47 CDC 2010 STD Tx Guidelines STD Screening for HIV+ Syphilis* Gonorrhea* Chlamydia* HSV-2 serology (consider if status unknown) Hepatitis B & Hepatitis A (if cost effective prior to vaccination) Hepatitis C Additional Screening for HIV+ women Pap Trichomoniasis Screen on initial evaluation (in non-emergent situations), frequency of screening based on risk. *At least annually for syphilis, GC, CT.

48 Chlamydia and gonorrhea STD Re-Screening Repeat testing for all infected is recommended at 3 months after treatment test of re-infection, not test of cure Syphilis Follow-up testing to monitor for cure Trichomoniasis Consider re-screening women 3 months after treatment (for re-infection and/or treatment failure) No data for men 48

49 STD Screening: Obstacles and Opportunity Benefit largely to community while cost/effort more immediate Competing demands Space, time, privacy Success from: Building into the intake process Urine-based tests Prompt processing with electronic reporting Nursing treatment protocols Public health department collaborations 49

50 Sharon Adler, MD, MPH Clinical Faculty California STD/HIV Prevention Training Center Clinical Specialist California Department of Public Health STD Control Branch 50

51 2010 STD Treatment Guidelines Relevant To Persons In Correctional Facilities 51

52 Overview CDC Treatment Guidelines development Treatment of STDs detected by intake screening Treatment/management of STD syndromes Additional resources 52

53 CDC STD Treatment Guidelines Development Evidence-based on principal outcomes of STD therapy Recommended regimens preferred over alternative regimens Alphabetized unless there is a priority of choice Reviewed April 2009; available December Pocket guides, teaching slides, wall charts 53

54 Case Scenario 22 year old female Asymptomatic, no prior STDs STD screening done on intake Urine NAAT testing for GC/CT and syphilis serology GC positive CT negative RPR non-reactive 54

55 What regimen would you use to treat gonorrhea? 1. Ceftriaxone 125 mg IM + azithromycin 1 g PO 2. Ceftriaxone 250 mg IM 3. Ceftriaxone 250 mg IM + azithromycin 1 g PO 4. Ofloxacin 400 mg PO 5. Ceftriaxone 125 mg IM 55

56 Antibiotic-Resistant Gonorrhea 56

57 Three Changes to Gonorrhea Treatment in Ceftriaxone IM preferred over oral cephalosporins 2. Ceftriaxone dose increased to 250 mg 3. Dual treatment for gonorrhea regardless of chlamydia test result CDC 2010 STD Treatment Guidelines: 57

58 Gonorrhea Treatment Uncomplicated Genital/Rectal Infections Ceftriaxone 250 mg IM in a single dose OR, if not an option: Cefixime 400 mg orally in a single dose PLUS* Azithromycin 1 g orally or doxycycline 100 mg BID x 7 days * Regardless of CT test result CDC 2010 STD Treatment Guidelines: 58

59 Gonorrhea Treatment Oropharyngeal Infections Ceftriaxone 250 mg IM in a single dose PLUS Azithromycin 1 g orally or doxycycline 100 mg BID x 7 days IN CASE OF SEVERE ALLERGY: Azithromycin 2 g orally once CDC 2010 STD Treatment Guidelines: 59

60 PCN and Cephalosporin Allergy ~5%-10% cross-reactivity risk with 1st generation cephalosporin in PCN allergic Cross reactivity low among 2nd and 3rd generation cephalosporin (used for GC treatment) in PCN allergic No evidence of increased anaphylaxis risk Cephalosporin allergy - Allergy 1%-3% exposed, usually rashes - Anaphylaxis is rare event Pichichero. Pediatrics 2005;115: Yates. Am Jour Medicine 2008;121:

61 Gonococcal Isolate Surveillance Project (GISP) Percentage of Neisseria gonorrhoeae Isolates with Resistance or Intermediate Resistance to Ciprofloxacin, Percentage Fluoroquinolones Year NOTE: Resistant isolates have ciprofloxacin minimum inhibitory concentrations (MICs) >1 µg/ml. Isolates with intermediate resistance have ciprofloxacin MICs of µg/ml. Susceptibility to ciprofloxacin was first measured in GISP in

62 Cephalosporin Susceptibility Among Neisseria gonorrhoeae Isolates- US, MMWR/July 8,2011/Vol. 60/No

63 Suspected GC Treatment Failure Retreat with ceftriaxone 250mg IM plus azithromycin 2 gm PO* - Consult ID expert/cdc regarding retreatment for ceftriaxone failure** Culture TOC within 1 week (NAAT if no culture) Partner treatment all within prior 2 months - Test for GC - Empirically treat dual therapy ceftriaxone/azithromycin Report to LHD/State within in 24 hours *MMWR/ July 8,2011 / Vol 60/No.5 (augments 2010 STD Treatment Guidelines) **Some states have RX recommendations, consult your state/lhd. CDC/State HD website to maintain updated content 63

64 What if her STD screening detected chlamydia? STD screening done on intake Urine NAAT testing for GC/CT and syphilis serology GC negative CT positive RPR non-reactive 64

65 Chlamydia Treatment Adolescents and Adults Recommended regimens (nonpregnant): Azithromycin 1 g orally in a single dose Doxycycline 100 mg orally twice daily for 7 days Recommended regimens (pregnant*): Azithromycin 1 g orally in a single dose Amoxicillin 500 mg orally TID x 7 days * Test of cure at 3-4 weeks only in pregnancy CDC 2010 STD Treatment Guidelines: 65

66 Case Scenario 29 year old male Asymptomatic, CT at age 21 STD screening done on intake Urine NAAT testing for GC/CT and syphilis serology GC negative CT negative Syphilis Treponemal EIA positive, RPR negative 66

67 What are appropriate next steps? 1. Treat him for Late Latent Syphilis 2. Request TP-PA testing 3. No action necessary, EIA+ is likely false positive 4. Treat him for Early Latent Syphilis 67

68 Syphilis Serologic Tests Nontreponemal tests RPR, VDRL & TRUST Treponemal tests FTA-ABS &TP-PA -Enzyme immunoassays (EIAs) Trep-Chek & Trep-Sure -Chemiluminescence immunoassays (CIAs) LIAISON & Architect -Microbeadimmunoassays (MBIA) BioPlex2200 Syphilis IgM & IgG 68

69 Reverse Sequence Syphilis Screening Treponemal tests (i.e., EIA, CIA) SPECIFIC TO TP QUALITATIVE REACTIVITY PERSISTS OVER LIFETIME reflex to Non-treponemal tests (i.e., RPR, VDRL) NOT SPECIFIC TO TP QUANTITATIVE REACTIVITY DECLINES WITH TIME CHALLENGES: Cannot distinguish between active/old disease (treated/untreated) Confusion re: management of patients with discrepant serology 69

70 Recommended algorithm for reverse sequence syphilis screening EIA or CIA EIA/CIA+ EIA/CIA- If incubating or primary syphilis is suspected, treat with benzathine penicillin G 2.4 million units IM x 1 Quantitative RPR Evaluate clinically, determine if treated for syphilis in the past, assess risk of infection, and administer therapy according to CDC s STD Treatment Guidelines if not previously treated RPR+ Syphilis (past or present) RPR- TP-PA Evaluate clinically, determine if treated for syphilis in the past, assess risk of infection, and administer therapy according to CDC s STD Treatment Guidelines if not previously treated MMWR / February 11, 2011 / Vol. 60 / No. 5 TP-PA+ Syphilis (past or present) TP-PA- Syphilis unlikely 70

71 Syphilis Treatment: Recommended Regimens Primary, Secondary & Early Latent:* Benzathine penicillin G 2.4 million units IM in a single dose Late Latent and Unknown Duration: Benzathine penicillin G 7.2 million units total, given as 3 doses of 2.4 million units each at 1 week intervals *No enhanced efficacy of additional doses of BPG, amoxicillin or other antibiotics even if HIV infected CDC 2010 STD Treatment Guidelines: 71

72 Sick Call: Urethral Discharge 22 year old male complaint of persistent dysuria & urethral discharge - Seen 1 week ago and treated for urethritis (ceftriaxone 250 IM plus azithromycin 1 gm PO) - States he initially felt a little better but the discharge never really went away. No sexual exposures in past week - GC/CT NAAT both negative from prior visit Urethral discharge confirmed on exam today 72

73 What treatment should he receive? 1. Ceftriaxone 250 mg IM + azithromycin 1 g PO 2. Doxycycline 100 mg PO BID x 7 days 3. Levofloxacin 500 mg PO daily x 7 days 4. Metronidazole 2 gm PO x 1 5. Retest for GC/CT today, no treatment needed 73

74 Urethritis: Common Infectious Causes Bacterial STDs: - GC ~20% - CT 15-40% Non-gonococcal urethritis (NGU) - Mycoplasma genitalium 15-25% - Ureaplasma <15%?; data inconsistent - Trichomonas vaginalis ~5-15% - HSV 2-3% (in absence of skin lesions) - Adenovirus, enterics, Candida, anaerobes Sexually Transmitted Diseases, 4 th Edition, Holmes et al 74

75 Persistent NGU Treatment Recommended regimens: Metronidazole 2 g orally in a single dose OR Tinidazole 2 g orally in a single dose PLUS Azithromycin 1 g orally in a single dose (if not used for initial episode) Moxifloxacin 400 mg PO x 7d effective for NGU treatment failures due to M. genitalium CDC 2010 STD Treatment Guidelines: 75

76 Sick Call: Genital Lesions 30 year old female very painful genital sores for 2 days History of CT and GC in her 20 s No known history of syphilis or herpes. 76

77 Genital, Perianal, Anal Ulcers Evaluation and Management History and physical examination often inaccurate Majority due to HSV or syphilis - Chancroid less common - Noninfectious causes Serologic test for syphilis Diagnostic evaluation for HSV HIV test Presumptive treatment based on clinical and epidemiology Biopsy if uncertain CDC 2010 STD Treatment Guidelines: 77

78 Genital Herpes Treatment 1 st Clinical Episode Recurrent Outbreaks (Episodic Rx) Acyclovir mg TID x 7-10 days mg 5x/day x 7-10 days Valacyclovir mg BID x 7-10 days Famciclovir mg TID x 7-10 days Higher doses/durations recommended for HIV (+) CDC 2010 STD Treatment Guidelines: Acyclovir mg TID or 800 mg BID x5 days mg TID x2 days Valacyclovir mg BID x3 days - 1 gm daily x 5 days Famciclovir mg BID x5 days mg x 1, then 250 mg BID x 2days mg BID x1 day 78

79 Sick Call: Vaginal Discharge 30 yr old HIV positive female treated for trich 4 weeks ago Patient states yellow/green discharge is back. RX metronidazole 2 gm at her last visit. No sex since RX. Trichomonas seen on wet mount today Seattle STD/HIV PTC 79

80 Trichomoniasis Treatment Failure First treatment failure, re-treat with: Metronidazole 500 mg PO BID x 7 days If repeat failure, treat with: Metronidazole 2 g PO x 5 days Tinidazole 2 g PO x 5 days Susceptibility testing: send isolate to CDC Consultation is available from CDC : CDC 2010 STD Treatment Guidelines: 80

81 Trichomoniasis Treatment Recommended regimen: Metronidazole 2 g PO x 1 Tinidazole 2 g PO x 1 Consider treating HIV-infected women: Metronidazole 500 mg PO BID x 7d Alternative regimen: Metronidazole 500 mg PO BID x 7d Recommended regimen in pregnancy: Metronidazole 2 g PO x 1 Note: Intravaginal therapy with metronidazole gel is ineffective Tinidazole is a Category C drug in pregnancy CDC 2010 STD Treatment Guidelines: 81

82 Trichomoniasis: Diagnosis Saline Wet Mount - Motile trichomonads - ph > Whiff test may be positive Culture (InPouch TV Test, BioMed Diagnostics) Point-of-care tests - OSOM trichomonas rapid test (Genzyme) - Affirm VP III (BD) New: Modified Nucleic Acid Amplification Tests - Roche Amplicor - Gen-Probe APTIMA Analyte Specific Reagents 82

83 Partner Management Options Partner management important for all STDs Patient referral - Ask patient to notify partner and ensure treatment - Internet-based anonymous notification Expedited partner treatment (EPT) - Legal for GC/CT in ~30 states Provider or clinic-based referral Health department referral 83

84 Additional Resources for Clinicians Managing STDs in the Correctional Setting: A Guide For Clinicians, 2 nd Edition - NCSD & Sylvie Ratelle STD/HIV PTC - STD management algorithms - Accessible online at NNPTC ( under Training Resources/Clinical Practice References 84

85 Additional Resources for Clinicians Academy of Correctional Health Professionals - American Correctional Association - American Correctional Health Services Association - National Commission on Correctional Health Care - Society for Correctional Physicians

86 Additional Resources for Clinicians CDC 2010 STD Treatment Guidelines National Network of STD/HIV Prevention Training Centers CDC Division of STD Prevention 86

87 Questions and Answers Questions can be submitted during the Webinar via the question function. Due to volume of Webinar participants and time we have allotted, we may not be able to provide live answers to all of the submitted questions. We will compile and answer salient questions and will post them online at and as soon as we can. 87

88 Continuing Education Information To receive CE credit, an evaluation must be completed at CDC s Training and Continuing Education Online site: If you have not previously registered as a participant on the CDC Training and Continuing Education Online site, click on New Participant to create a user ID and password; otherwise click on Participant Login. Once logged on to the CDC Training and Continuing Education Online site, you will be on the Participant Services page. Click on Search and Register. For those participating in the program on November 9, 2011 through December 8, 2011, enter EC1956 into the Keyword Search box and then click on view. For those participating in the program on or after December 9, 2011, enter WD1956 into the Keyword Search box and then click on view. 88

89 Continuing Education Information Select the webinar that you viewed. The course information page will come up. Scroll down to the Register Here section of the page. Click on the type of continuing education credit that you would like to receive and then Submit. A few demographic questions will come up. Complete the questions and then Submit. A message will come up thanking you for registering for the course. Complete and Submit the evaluation and posttest. A record of your course completion and your CE certificate will be located in the Transcript and Certificate section of the Participant Services page. Print out a copy of your certificate and send it to the appropriate accrediting agency (ACCME, ACPE, ANCC, NCHEC, etc.) so that they will have a record of your certificate. 89

90 Emerging Issues in Sexually Transmitted Diseases Managing STDs in Correctional Settings: Behind the Walls November 9, 2011 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention

91 Acknowledgments Rheta Barnes Blanche Collins Janine Dyer Barbara Gray Suzanne Haecker Kathy Hsu Nina Martinez Sheila McKenzie Raul Romaguera Kim Workowski 91

92 For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention